阿那曲唑对绝经后乳腺癌患者血脂的影响

Effects of anastrozole on lipid metabolism in Chinese postmenopausal women with breast cancer

目的观察阿那曲唑辅助治疗对中国绝经后乳腺癌患者血脂代谢的影响及其他不良反应。方法需要术后辅助内分泌治疗的绝经后乳腺癌患者285例，给予阿那曲唑1mg，1次／d，分别检测其服药前及服药后3个月、6个月、1年、2年、3年、4年和5年的总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TG）水平。电话随访服药过程中出现的其他不良反应。结果285例患者的中位服药时问为3.6年。服药6个月后即导致LDL-C升高，持续至服药后第5年，其中服药后第4年最高，为（3．64±0．96）mmol／L，较服药前[（3．08±0．90）mmol／L]升高18．2％。服药1年后，TC和HDL-C外始升高，并持续至服药后第4年，TG无明显变化。亚组分析硅示，对于服药前伴有高血脂的患者，除服药后1年出现TC升高（随后恢复）外，阿那曲唑对高血压患者的血脂无明显影响；相对于〈60岁的患者，阿那曲唑对于年龄〉／60岁患者的血脂影响更明显。服药过程中出现的其他不良反应包括潮热、骨关节疼痛、烦躁、恶心呕吐、腹泻、乏力、阴道干燥、体重增加、阴道出血、骨折、皮疹等，均较轻微，患者可耐受。结论绝经后乳腺癌患者术后接受阿那曲唑辅助内分泌治疗，可导致血脂代谢的变化，主要表现为TC、LDL-C，HDL-C升高，尤其对于年龄≥60岁的患者影响更加明显。建议长期口服阿那曲唑的患者定期复查血脂。其他小良反应轻微，患可耐爱。

Objective The aim of this study was to evaluate the effect of anastrozole, a new generation aromatase inhibitor, on the lipid metabolism in postmenopausal Chinese women with early breast cancer, and observe the adverse reactions as well. Methods Postmenopausal women with early breast cancer patients took anastrozole 1 mg per day. The lipid profiles of total cholesterol, trig]yeeride, low density lipoprotein, and high density lipoprotein were assessed before taking the drug, 3 months, 6 months after taking medication, and later once a year, until the end of medication or follow-up. Patients taking lipidlowering drugs were excluded. The adverse reactions during the process of taking medication was followed-up by telephone. Results Two hundred and eigbty-five postmenopausal breast cancer patients took part in the trial from Jan. 2003 to Jun. 2009. All patients had completed primary surgery and demonstrated a postmenopausal status. ER or PR positivity was conffrmed by histopathology. Taking the medication fi＇om a minimum of one year to a maximum of 5 years,with a median time of 3.61 years. During the medication time, anastrozole significantly increased the levels of low density lipoprotein-cholesterol after 6 months of treatment, continueing to 5 years, from （ 3.08 ± 0.90） mmol/L to （3.59 ± 0.59） retool/L, with a maximal increase of 18.2% higher than that before medication. Anastrozole significantly increased the levels of total cholesterol and high density lipoprotein-cholcsterol after 1 years of treatment. Anastrozolc significantly reduced the levels of triglycerides after 1 years of treatment. Anastrozole showed no significant effect on serum lipids in the patients with pre-existing hyperlipidemia. A more significant effect on blood lipids was observed in patients aged ≥ 60-years than that in patients less than 60 years of age. The rate of other adverse events were similar to that reported in foreign patients. Conclusions For the postmenopausal patients with breast cancer, taking anastrozole may lead to an abnormal lipid metabolism. Anastrozote significantly increases the levels of low density lipoprotein-cholesterol, total cholesterol and high density lipoprotein-cholesterol, and significantly reduces the level of ~nglyeeri^es. The rate of other a^Terse events were similar to that reported in foreign patients, it is suggested that the blood lipid levels should be regularly assessed in patients with long-term anastrozole treatment. The rate of other adverse events similar to that reported with foreign patients, and patients tolerate this treatment well.